Communities have trouble attracting doctors

By JENNIFER BOOTH REED
http://www.news-press.com

In any other industry, a work force shortage might be eased with a boost in salary levels and a sweeter benefit pool.

But this is health care, and nothing is ever as simple.

Even if Lee Memorial Health System succeeds in starting a medical residency program, the initiative may not be enough to counter other forces dissuading physicians from practicing in Florida.

Some of the problems, such as the doctors’ choices of specialties and government insurance rates, aren’t really controllable at a local level.

In 2004, Lee Memorial Health System commissioned a study that found the county might be short as many as 225 doctors by 2009. The research firm looked at population growth and factored in the number of doctors expected to retire. The biggest holes, it found, could be in family care and pediatrics.

It’s difficult to know where the situation stands now.

“I would assess us as staying status quo,” said Dr. Charles Krivenko, the chief medical officer for clinical and quality services. “We’re holding our own though there are some major challenges.”

The system has hired or helped private practices recruit nine surgeons, a plastic surgeon to work in the trauma center and three infectious disease doctors. But others have left, including five cardiologists who departed in 2005.

The Florida Department of Health shows there are 1,201 doctors licensed to practice in Lee. That gives the community of about 585,608 residents about one doctor for every 488 people.

But that figure doesn’t tell whether all those license holders are practicing full time, nor does it indicate whether there are gaps in any specialty.

“The biggest issue is they’re not training enough doctors,” said cardiologist Dr. Erick Burton, president of the Lee County Medical Society.

The push for managed care in the 1990s resulted in medical schools pushing primary care and curtailing training of specialists. Burton said he believes the region now faces a shortage in some areas, particularly general surgeons.

Yet on the other hand, Dr. John Ritroski of Physician Primary Care Pediatrics said his practice had just hired a new doctor and he knows of another pediatric group that had just done the same.

Kevin Newingham, Lee Memorial’s corporate director of planning and strategy, said the system is about to update the 2004 study. The Florida Medical Association also is working with the state to study the supply and demand of physicians, said Francie Plendl, the FMA director of governmental affairs. There is no data on who is actively practicing in Florida, as opposed to simply holding a Florida license, Plendl said.

Here are some of the obstacles communities are up against when it comes to bringing in new doctors:

Money

After seven or more years of training, doctors expect to make a few bucks.

Medical students are graduating with as much as $150,000 in loans.

“Physicians in this community want to be paid as well as they are in Atlanta or Charlotte, N.C.,” Krivenko said.

Easier said than done.

About 24 percent of Lee County’s residents don’t have insurance, making the county the No. 2 spot in the state behind Dade County in the rate of uninsured people. Thousands of others depend on Medicaid, the government health provider for the poor, or on Medicare. Doctors say the government reimbursement rates, especially for Medicaid, don’t reflect their costs to deliver care.

It costs doctors about $80 to see a patient; Medicaid reimburses them about $30, according to Plendl of the Florida Medical Association.

States set the Medicaid reimbursement rates.

Federal Medicare rates for senior citizen care also have dropped in the past few years, health care executives said.

Consider: In the United States this year, there are just two pediatric neurosurgeons being trained, said Dr. John Iacuone, director of the Children’s Hospital of Southwest Florida.

Liability and Medicaid reimbursement just doesn’t make the field an attractive one, he said.

Malpractice

Good news, Plendl said. Recent reforms capping the amount lawyers can collect from malpractice rates seem to have slowed down the number of lawsuits filed. That, in turn, seems to be helping ease the cost of malpractice insurance.

Still, Florida doctors pay more than doctors in most states for malpractice insurance. And some areas of the state, such as South Florida, are more litigious than others. Doctors are not only picking less risky specialties, but they’re setting up practices in areas where they’re less likely to be sued, Plendl said.

In Florida, a doctor with three malpractice judgements on his record faces losing his license.

“I think the practice climate is enormously tough,” said Dr. Jenny Mladenovic, the senior associate dean for graduate medical education at the University of Miami. “Kids hear this and say, ‘I love the training, but I want to get out of Florida.'”

Lifestyle

It appears that endless workdays and middle-of-the-night emergency calls aren’t appealing to young graduates.

Statistics aren’t yet clear, but it appears young doctors are choosing specialties that don’t demand round-the-clock attention.

“Getting up at 2 in the morning is tough. Some physicians would opt not to do that,” Krivenko said.

University deans see the shifts among students.

“There’s no question that a lot of graduating students are choosing lifestyle specialties,” said Dr. Robert Watson, the senior associate dean for educational affairs at the University of Florida’s College of Medicine. “Fewer students, especially U.S. graduates, are going into primary care. They’re not going into internal medicine.”

Hospital role

The big unknown is whether Lee’s abruptly changed hospital climate will draw or dissuade physicians — or whether it will have any discernable impact at all. Lee Memorial last fall purchased its competitor, Hospital Corporation of America’s Southwest Florida Regional Medical Center and Gulf Coast Hospital.

Southwest had been established in the 1970s by local doctors who wanted an alternative to Lee Memorial.

Lee Memorial officials argue a single-hospital system might be able to provide a less fragmented system and a more cost-effective one. Lee is nonprofit and officials say they’ll stop spending money just to keep pace with the competition.

Will doctors want to be a part of Lee Memorial’s experiment in reshaping health care? Or will they be turned off by the dominance of the system?

The question may take a little time to answer.
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